Modular telehealth cart with thermal imaging and touch screen user interface

ABSTRACT

A telemedicine system including a cart that allows for two-way audio/video conferencing between patients or local care providers and remote care providers or family members. The cart employs a modular design that allows its capabilities to be expanded to meet the needs of particular telemedicine applications. In addition, the cart provides thermal imaging and a user interface that allows local care provers to access various capabilities of the device while the device is not in session with a remote party.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.16/687,431, filed Nov. 18, 20219, pending, which is a continuation ofU.S. application Ser. No. 16/045,600, filed Jul. 25, 2018, now U.S. Pat.No. 10,483,007, which claims priority to U.S. Application No.62/536,907, filed Jul. 25, 2017, the contents of which are herebyincorporated by reference.

BACKGROUND

Telemedicine, also referred to as telehealth, generally refers to theuse of technology to enable physicians or other healthcare providers toexamine and treat or recommend treatment for a remotely located patient.Although telemedicine can be practiced using technology as simple as atelephone, the telemedicine solution market today includes devices andsoftware having a wide range of sophistication. Examples of telemedicinedevices include the INTOUCH XPRESS, INTOUCH VICI, INTOUCH VANTAGE,INTOUCH LITE, and INTOUCH VITA, all marketed by INTOUCH TECHNOLOGIES,INC., of Goleta, Calif.

The range of solutions generally intends to satisfy the functional andeconomic requirements of telemedicine encounters in different types ofsettings with varying levels of acuity. For example, smartphones,tablets, or laptop computers with basic audiovisual capabilities may besufficient for a patient to consult with their doctor on treating a coldor behavioral health issues. These types of devices, however, may beinsufficient in a higher acuity setting such as a hospital emergencydepartment, intensive care unit, or specialty clinic, where the remotephysician may require more capable video or imaging devices and/or theability to monitor data from peripheral medical devices in real time.Other settings where telemedicine is practiced may present other uniquerequirements.

Thus, the telemedicine solution market is replete with disparate devicesand software solutions that seek to satisfy the varied requirements ofmany different telehealth encounter settings. In addition, while many ofthese devices offer great value in terms of their ability to providereal-time audio/video consultation between remote parties, few of thesedevices provide any value to local care providers when not being used ina session with a remote care provider.

SUMMARY

It would be desirable to provide a telemedicine device with broadereconomic suitability by employing a modular design that allows thedevice's functionality to be expanded for applications that demand it.For example, it would be beneficial to include an integrated overheadboom camera for neonatal intensive care applications or any applicationinvolving a sterile field. Further, it would be beneficial to include anintegrated peripheral expansion bay and/or thermal camera for certaincare applications.

In addition, it would be desirable to provide a telemedicine device thatincludes features and/or services that can be utilized by local careproviders even when a remote care provider is not logged in to thedevice. For example, it would be valuable to allow local care providersto request a remote consultation from the device itself. The request forconsultation could be for a medical consultation with a remotephysician, a family member consultation with a member of the patient'sfamily, or a language translation service in situations where thepatient and/or members of the care team do not speak a common language.It would also be valuable to allow local care providers to control anycameras installed on the device and monitor video from these cameras ona display of the telemedicine device when the device is not in sessionwith a remote care provider.

To achieve these ends, one aspect of the disclosure includes atelemedicine system comprising a cart that supports a controller coupledto a camera system, a touchscreen display, a microphone, a speaker, anda network. The controller is configured to display a user interface onthe touchscreen display in response to a user input received via thetouchscreen display. The user interface includes at least a firstselectable option that causes video captured by the camera system to bedisplayed on the touchscreen display and a second option to transmit arequest for consultation via the network. The telemedicine system alsoincludes a remote device coupled to the controller via the network. Theremote device includes a camera, a display, a microphone, and a speaker.The remote device is configured to establish a communication sessionwith the controller. During the communication session, the controllercauses the touchscreen display to display video captured by the cameraof the remote device.

BRIEF SUMMARY OF THE DRAWINGS

FIG. 1 illustrates a view of a telemedicine cart in accordance with thedisclosure.

FIG. 2 illustrates a second view of a telemedicine cart in accordancewith the disclosure.

FIG. 3 illustrates a rear view of a telemedicine cart in accordance withthe disclosure.

FIG. 4 illustrates an example of a telemedicine cart with an overheadboom camera installed in accordance with the disclosure.

FIGS. 5A-B illustrate detailed views of the head of a telemedicine cartin accordance with the disclosure.

FIG. 6 illustrates another view of a telemedicine cart in accordancewith the disclosure.

FIGS. 7A-D illustrate various screens of a user interface of atelemedicine cart in accordance with the disclosure.

FIG. 8 is a block diagram of electronic components of a telemedicinecart in accordance with the disclosure.

DETAILED DESCRIPTION

The following disclosure includes a telemedicine system including a cartthat allows for two-way audio/video conferencing between patients orlocal care providers and remote care providers or family members. Thecart employs a modular design that allows its capabilities to beexpanded to meet the needs of particular telemedicine applications. Inaddition, the cart provides a number of features to local care proversthat can be accessed while the device is not in session with a remoteparty.

FIGS. 1-2 illustrate several views of an example of a telemedicine cart10 in accordance with the disclosure. The cart 10 includes a base 12, atrunk 14, a neck 16, and a head 18. The base 12 may include casters 20that allow the cart 10 to be wheeled around a healthcare facility. Thecasters 20 may include wheel locks 22 for locking the wheels andimmobilizing the cart 10 in its desired location. The base 12 may houseone or more batteries (not shown) that power the various electrical andelectronic components of the cart. The base may also house a batterycharger coupled to a power supply that includes an AC power cord 24 thatcan be plugged into a wall socket to energize the power supply.

The trunk may include a receptacle 26 for a privacy handset 28 thatallows a person in the vicinity of the cart 10 to communicate privatelywith a remote user logged into the device. As shown in FIG. 2, the trunk14 may also include a peripheral expansion bay 30 that includes one ormore communication ports, including USB ports, HDMI ports, ETHERNETports, etc. The trunk 14 may also include a status indicator panel 36that displays the status of various elements of the cart. For example,the status indicator panel 36 may display current battery life or chargelevel and wireless network strength. As shown in FIG. 3, the rear of thetrunk may also include a storage bin 32 with a door 34 that can be shutand latched. The storage bin 32 may be used to stow medical peripheralswhen not use. Examples of medical peripherals include stethoscopes,otoscopes, dermal cameras, etc.

The neck 16 extends up from the trunk 14 along a track (not shown) thatruns vertically up the trunk. The neck 16 may be moved up or down alongthe track to shrink or elongate the neck 16 and vary the height of thehead 18. The track may employ friction elements, latches, springs,and/or counter weights (not shown) to achieve smooth movement of theneck 16 along the track and ensure that the neck 16 and head 18 remainat the desired height when not being raised or lowered. The variablelength of the neck 16 may allow the height of the head 18 to be variedfrom approximately four feet above the floor to six feet above thefloor. The top of the neck 16 may include a mount point 38 adapted toreceive one end of an articulating boom 40 that supports an additional,overhead pan-tilt-zoom (PTZ) camera 42, as shown in FIG. 4. Thisconfiguration is beneficial in, e.g., a neonatal intensive careenvironment in which local care providers will often surround an infantbed 44 and the overhead camera 42 is crucial for the remote careprovider to view the infant. This configuration is also beneficial inany environment in which there is a sterile field that precludes movingthe cart 10 within a certain distance of the patient without requiringsubsequent sterilization, as is the case for many surgical procedures.

FIGS. 5A-B show an example of the head 18 of a cart in accordance withthe disclosure. The head 18 includes a camera system 46, one or moremicrophones 48, one or more speakers 50, and a touchscreen display 52all coupled to a controller (not shown), which may be located in thehead, the base, or any other suitable location in the cart. The camerasystem 46 may include a first optical camera 54 having a wide field ofview or viewing angle and a second optical camera 56 having a narrowfield of view with a higher zoom factor than the first optical camera54. The controller may stream video from both optical cameras 54, 56over the network to the remote device for display simultaneously, or thecontroller may switch the video stream being sent to the remote devicebetween the first optical camera 54 and the second optical camera 56depending on the zoom factor or field of view requested by the user ofthe remote device. Further details of a multi-camera teleconferencingsystem are discussed in U.S. Pat. No. 9,198,728, filed Sep. 30, 2005,entitled “Multi-Camera Mobile Teleconferencing Platform”, the contentsof which are hereby incorporated by reference.

The camera system may also include a thermal camera 58. An example of asuitable thermal camera is the BOSON 320 Camera Core manufactured byFLIR. The thermal camera may aid a physician or care provider indiagnosing a variety of conditions that may be invisible to the eye oroptical cameras 54, 56 but result in irregular or otherwise unusual heatpatterns on the patient's body. For example, irregular heat patternssuch as “hot spots” on the patient's body may be indicative of localizedtrauma, infection, or irritation. Other patterns such as asymmetricblood flow in the limbs or the face may be indicative of ischemic strokeor other conditions that result in irregularities in the patient's bloodflow. In addition to spatial anomalies in the patient's body heat, thethermal camera 58 may allow a care provider to detect temporalirregularities in the patient's temperature by analyzing temperaturetrends in images from the thermal camera 58 taken over time. The systemmay also be configured to use computer vision techniques to analyze theimages captured by the thermal camera 58 and automatically detectspatial and temporal temperature irregularities discussed above. Furtherdetails of the use of thermal imaging devices in medical andtelemedicine applications can be found in U.S. patent application Ser.No. 13/111,208, filed May 19, 2011, entitled “Mobile VideoconferencingRobot System with Autonomy and Image Analysis”, and U.S. applicationSer. No. 14/091,292, filed Feb. 13, 2014, entitled “Enhanced Diagnosticsfor a Telepresence Robot”, the contents of which are hereby incorporatedby reference.

In addition, a user interface for the thermal camera 58 such as thatdiscussed in U.S. Appl. No. 62/536,907, the contents of which areincorporated by reference, may be available either on the touchscreendisplay as well as at a remote device logged into the cart. Thisinterface makes available certain features such as temperature and colorthresholding and measuring a point-to-point temperature differential onthe patient's body using cursors positioned by the user on the thermalimage displayed in the interface.

Although their viewing angles and zoom factors may be different, thevarious cameras 54, 56, 58 of the camera system in the head 18 of thecart are closely positioned and similarly oriented so as to allowswitching between their respective streams while maintaining a similarperspective of the environment. For example, each of the cameras mayface the same direction and be positioned less than three inches apart.

As shown in FIG. 6, the head 18 may be coupled to the neck 16 via a panjoint 46 and a tilt joint 48 that allow the head 18 to be panned and/ortilted relative to the neck 16. The joints 46, 48 may include motorizedactuators that allow the pan and or tilt angles of the head 18 to becontrolled remotely or via a control interface on the cart 10. Thepanning and tilting head 18 allows the remote user to reorient thecamera system 46 to look around the environment surrounding the cart 10.The touchscreen display 52 may pan and tilt with the camera system 46and always face the same general direction in which the camera system 46faces. This creates the impression that the remote user is in the roomand looking around the room in much the same way as a person actually inthe room would. This provides an enhanced sense of the remote user'spresence to people in the vicinity of the cart 10. The pan and tiltactuators between the neck 16 and the head 18 are also designed so as toallow the pan and tilt angle of the head 18 to be manually adjusted auser in the vicinity of the cart 10 by tilting or rotating the head 18by hand.

FIG. 7A illustrates an example of a screen saver 60 that may bedisplayed as part of a user interface 62 on the touchscreen display 52of the cart 10 when the system is idle. Touching the touchscreen 52 orotherwise interacting with the cart may cause the user interface 62 totransition the touchscreen display 52 from the screen saver 60 depictedin FIG. 7A to the menu 64 shown in FIG. 7B.

The menu illustrated in FIG. 7B may include a number of selectableoptions 66 including requesting a consultation with a remote physicianor care provider. The menu 64 may display one or more different types ofconsultations, which may result in the request for consultation beingsent to a specific care provider. Alternatively, any request for consultmay simply sent to a general care coordination center with the requestedtype of consultation included in the request. Personnel at the carecoordination center may then forward the request to the appropriate careprovider. The various consultation types illustrated in FIG. 7B includeneonatal resuscitation, critical care, acute stroke, behavioral health,and cardiologist. Those skilled in the art will recognize that manyother types of consultations may be available for request.

Another selectable option 66 from the menu screen shown in 6B is“translation.” When the user selects this option, the system maytransmit a request for consult to a multi-lingual translator who canthen log into the cart from their remote device and translate amongparties who do not speak a common language. Upon selecting thetranslation option, the system may present another menu of specificlanguage translation options (e.g., “Spanish”, “French”, etc.) that canbe chosen to identify an appropriate translator. Alternatively,selecting the language translation option may send a request for atranslator to personnel who may then locate an appropriate translator.The language translation service mode may include an option to mutevideo from any camera on the cart for privacy reasons.

The menu in FIG. 7B may also include a “friends and family” option thatallows a user in proximity of the device to request a consultation witha member of the patient's family or friend group. When this option isselected, the touchscreen display may prompt the user for a telephonenumber, email address, or other communication address. The user mayenter the requested information using alphanumeric keys displayed on thetouchscreen, voice recognition, external keyboard, or other means. Oncethe requested information has been supplied, the controller may thentransmit a message, e.g., a text message or email, to the providedaddress. The message may include a universal resource locator or otherlink that can be selected to launch a specific application on therecipients device that can connect to and establish a communicationsession with the cart via the internet. Alternatively, the link maysimply direct a web browser on the recipients device to a web portalthat allows the remote user's device to connect to and establish acommunication session with the cart.

Once connected, or “in session,” the cart may display video receivedfrom a camera of the remote user's device on the touchscreen display. Inmany cases, this video 68 will include the face of the remote user, asillustrated in FIG. 7C. In addition, video from the cart's camera system(or overhead camera) will be streamed to and displayed on a display ofthe remote user's device. This video may also be displayed on thetouchscreen display of the cart in a picture-in-picture window 72. Thecart microphone and speaker will be coupled to the speaker andmicrophone of the remote user's device so that people in the vicinity ofthe cart and the remote user(s) can hear each other.

By interacting the with user interface of the application on the remotedevice, the remote user can control the pan, tilt, and zoom of thecamera system to look around the cart's environment. The remote user canalso select to display video from any combination of the opticalcamera(s), the thermal camera, and the overhead camera. The userinterface on the remote device may include a multi-view function thatallows the user to simultaneously stream and view video from any two ormore of the cameras coupled to the cart, including any imaging devicesthat may be connected to the cart's expansion bay, such as an otoscopeor sonogram device. By way of example, the user may train the camerasystem to view the patients leg with the optical camera andsimultaneously display video from the thermal camera to assist inidentifying an irregular heat pattern on the patient's leg. Furtherdetails of an exemplary user interface for a remote device intelemedicine system can be found in U.S. application Ser. No.10/962,829, filed Oct. 11, 2004, entitled “Graphical interface for aremote presence system”, U.S. Pat. No. 9,361,021, filed Nov. 21, 2014,entitled “Graphical User Interfaces Including Touchpad Driving forTelemedicine Devices”, and U.S. Pat. No. 9,098,611, filed Mar. 14, 2013,entitled “Enhanced Video Interaction for a User Interface of aTelepresence Network”, the contents of which are hereby incorporated byreference.

Another selectable option 66 available from the menu screen in FIG. 7Bmay be to display video from any imaging devices connected to the cart,including the optical camera(s), thermal camera, overhead camera, or anyimaging devices connected to the expansion bay. For example, FIG. 7Dillustrates an example of the touchscreen interface displaying a thermalvideo image 72 captured by the thermal camera on the cart. Even thoughthe cart is not in session with a remote care provider, a local careprovider may wish to view the patient's body using the thermal camera.In this case, the user may simply select, from the menu on thetouchscreen display, to display the video from the thermal camera on thetouchscreen display. The video from the thermal camera may then bedisplayed on the touchscreen and the user can adjust the height, pan,and/or tilt of the head to train the thermal camera on the desired partof the patient's body. The system may also allow the user to change thezoom factor of the displayed video using “pinch” or “spread” gestures onthe touchscreen, or manipulating buttons or slider bars displayed on thetouchscreen.

If the cart is configured with an the overhead boom camera, thetouchscreen interface may also allow the user to display video from theoverhead camera on the touchscreen interface and allow the user toadjust the pan, tilt, and zoom of the overhead camera. This isespecially useful when the user is positioning the cart and adjustingthe boom height in preparation for a consultation with a remote careprovider who will utilize the overhead camera to view a sterile field orinfant bed.

The menu displayed in FIG. 7B may also include an option for a localcare provider to open or launch a clinical protocol, workflow, orotherwise open and edit a medical form or record using the touchscreeninterface. For example, when a patient arrives for a telehealthconsultation with a remote physician, a nurse or medical assistant mayopen a medical record for the patient using the touchscreen interfaceand begin documenting the encounter, including entering the patient'scurrent vital signs into the record before the remote physician isnotified that the patient is ready to begin the consultation. In anotherembodiment, if a patient arrives in an emergency department showingsigns of a stroke, a nurse or doctor may launch a stroke consult form orworkflow using the touchscreen interface and begin documenting theencounter and proceeding through the various steps prescribed in themedical facility's stroke protocol. Further details regarding editingpatient records and documenting clinical encounters during atelemedicine encounter can be found in U.S. patent application Ser. No.10/936,041, filed Sep. 7, 2004, entitled “Tele-presence system thatallows for remote monitoring/observation and review of a patient andtheir medical records”, U.S. Pat. No. 8,179,418, filed Apr. 14, 2008,entitled “A Robotic Based Health Care System”, U.S. Pat. No. 8,849,680,filed Jan. 29, 2009, entitled “Documentation Through A Remote PresenceRobot”, and U.S. application Ser. No. 15/965,623, filed Apr. 27, 2018,entitled “Telehealth Cart that Supports a Removable Tablet with SeamlessAudio/Video Switching”, the contents of which are hereby incorporated byreference.

FIG. 8 illustrates a block diagram of the various electrical componentsof a telemedicine cart in accordance with the disclosure. The cartincludes a CPU or controller that may take the form of a computerrunning Microsoft Windows, LINUX, UNIX, MAC OS, or other similaroperating system. The cart may include first and second optical cameras54, 56 as well as a thermal camera 58 and an overhead camera 42. Theoverhead camera may be a PTZ camera and have a separate controlinterface 76, such as an RS-232 interface, that provides enhancedcontrol of the actuators that control the pan, tilt, and zoom of theoverhead camera 42. The cart may also include a touchscreen display 52coupled to the controller 74 that can display images, including videoand the user interface described above, as well as receive touch inputfrom the user to provide to the controller. The cart may also include atleast one speaker 50 and at least one microphone 48 coupled to thecontroller 74. The controller 74 is coupled to at least one networkadapter 78 to allow the controller 74 to communicate with other devicesover a network, such as the Internet. The one or more network adapters78 may include wired network adapters (such as Ethernet) and wirelessnetwork adapters such as WIFI and Bluetooth. The cart may also include aperipheral port expansion bay 30 coupled to the controller 74. Theperipheral ports may include HDMI, Ethernet, USB, and other interfacesfor connecting to external medical devices, imaging devices, audiodevices, input devices, and the like. The cart also includes an AC plug24 coupled to a power supply 80 that powers the various electricalcomponents of the cart. The power supply 80 may include a batterycharger 82 coupled to a battery 84 to power the cart when the AC plug 24is not plugged into an AC power source. Some components, such as theoptical and thermal cameras, the touchscreen display, the microphone,and the speaker may be mounted together in the head of the cart whichmay have pan and tilt control provided by head pan/tilt actuators 86,which are coupled to and controlled by the controller 74.

Additionally, as will be appreciated by one of ordinary skill in theart, principles of the present disclosure may be reflected in a computerprogram product on a computer-readable storage medium havingcomputer-readable program code embodied in the storage medium, thecomputer-readable program code executable by a processor. Any tangible,non-transitory computer-readable storage medium may be utilized,including magnetic storage devices (hard disks, floppy disks, and thelike), optical storage devices (CD-ROMs, DVDs, Blu-Ray discs, and thelike), flash memory, and/or the like. These computer programinstructions may be loaded onto a general purpose computer, specialpurpose computer, or other programmable data processing apparatus toproduce a machine, such that the instructions that execute on thecomputer or other programmable data processing apparatus create meansfor implementing the functions specified. These computer programinstructions may also be stored in a computer-readable memory that candirect a computer or other programmable data processing apparatus tofunction in a particular manner, such that the instructions stored inthe computer-readable memory produce an article of manufacture,including implementing means that implement the function specified. Thecomputer program instructions may also be loaded onto a computer orother programmable data processing apparatus to cause a series ofoperational steps to be performed on the computer or other programmableapparatus to produce a computer-implemented process, such that theinstructions that execute on the computer or other programmableapparatus provide steps for implementing the functions specified.

The foregoing specification has been described with reference to variousembodiments. However, one of ordinary skill in the art will appreciatethat various modifications and changes can be made without departingfrom the scope of the present disclosure. Accordingly, this disclosureis to be regarded in an illustrative rather than a restrictive sense,and all such modifications are intended to be included within the scopethereof. Likewise, benefits, other advantages, and solutions to problemshave been described above with regard to various embodiments. However,benefits, advantages, solutions to problems, and any element(s) that maycause any benefit, advantage, or solution to occur or become morepronounced are not to be construed as a critical, a required, or anessential feature or element. As used herein, the terms “comprises,”“comprising,” and any other variation thereof, are intended to cover anon-exclusive inclusion, such that a process, a method, an article, oran apparatus that comprises a list of elements does not include onlythose elements but may include other elements not expressly listed orinherent to such process, method, system, article, or apparatus. Also,as used herein, the terms “coupled,” “coupling,” and any other variationthereof are intended to cover a physical connection, an electricalconnection, a magnetic connection, an optical connection, acommunicative connection, a functional connection, and/or any otherconnection.

While the principles of this disclosure have been shown in variousembodiments, many modifications of structure, arrangements, proportions,elements, materials, and components, which are particularly adapted fora specific environment and operating requirements, may be used withoutdeparting from the principles and scope of this disclosure. These andother changes or modifications are intended to be included within thescope of the present disclosure.

What is claimed is:
 1. A telemedicine system comprising: a cart thatsupports a controller coupled to a camera system, a touchscreen display,a microphone, a speaker, and a network, the controller is configured todisplay a user interface on the touchscreen display in response to auser input received via the touchscreen display, the user interfaceincluding at least a first selectable option that causes video capturedby the camera system to be displayed on the touchscreen display when thesystem is not in session and a second option to transmit a request forconsultation via the network, wherein the controller is configured toestablish a communication session with a remote device coupled to thecontroller via the network, the remote device including a camera, adisplay, a microphone, and a speaker and, during the communicationsession, the controller causes the touchscreen display to display videocaptured by the camera of the remote device.
 2. The system of claim 1,wherein the camera system includes a thermal camera.
 3. The system ofclaim 2, wherein the camera system includes a first optical camera witha first field of view.
 4. The system of claim 3, wherein the camerasystem includes a second optical camera with a second field of view. 5.The system of claim 4, wherein the cart further comprises anarticulating boom that supports a third optical camera coupled to thecontroller, the third optical camera having a third field of view. 6.The system of claim 5, wherein the third optical camera is apan-tilt-zoom camera.
 7. The system of claim 6, wherein the controllerchanges at least one of the pan, tilt, and zoom of the third opticalcamera in response to a user input provided via the touchscreen display.8. The system of claim 6, wherein the controller changes at least one ofthe pan, tilt, and zoom of the third optical camera in response to auser input received from the remote station.
 9. The system of claim 1,wherein the camera system and the touchscreen display can be panned andtilted relative to the cart.
 10. The system of claim 9, wherein thecamera system and the touchscreen display are mechanically coupled suchthat they face in substantially the same direction and move together.11. The system of claim 9, wherein the cart includes actuatorsconfigured to pan and tilt the camera system and the touchscreen displayin response to commands received from the remote station.
 12. The systemof claim 11, wherein the actuators are configured to be manuallyrepositioned by a person in the vicinity of the cart.
 13. The system ofclaim 1, wherein the user interface displays a plurality of selectableconsultation types that can be selected to request a consultation. 14.The system of claim 13, wherein selecting a first consultation typecause a consultation request to be transmitted to a first care providerand selecting a second consultation type causes a consultation requestto be transmitted to a second care provider.
 15. The system of claim 1,wherein the user interface includes a selectable option that causes thecontroller to display a medical form that can be completed via thetouchscreen interface.
 16. The system of claim 1, wherein the controllercauses the user interface to display a prompt for a telephone number andsubsequently transmits the consultation request to a telephone numberprovided by the user via the touchscreen interface in response to theprompt.
 17. The system of claim 1, wherein the consultation request istransmitted via a Short Message Service protocol and includes a uniformresource locator.
 18. The system of claim 17, wherein the recipient ofthe consultation request can select the uniform resource locator toactivate an application that establishes the communication session withthe controller.
 19. The system of claim 1, wherein the user interfaceincludes a selectable option for a language translation service.
 20. Thesystem of claim 1, wherein the cart includes a removable peripheral baythat includes a plurality of communication ports coupled to thecontroller.